<!-Confirm Payment Amount //-->
<div class="confirm-payment-amount popup">
	<div class="title">Confirm Payment Amount</div>
	<div class="content">
		<form action="http://www.google.com" method="" onsubmit="parent.$.fancybox.close();">
			<fieldset>
				<p><label for="account_no">Account No</label>822924254</p>
				<p><label for="amount_due">Amount Due</label>RM213.25</p>
				<p><label for="payment">Payment</label><input type="text" name="payment" value="213.25" /></p>
				<small><strong>Note</strong><br />
					Transactions allowed only in Malaysian Ringgit (RM). Please contact your issuing bank for any dispute or complaints related to this payment. Your payment details will be securely transmitted using SSL 128 bit encryption.</p>
				</small>
				<p class="align_center"><img src="images/verified.gif" alt="Verified by Visa. Mastercard Securecode" /></p>
				<p class="align_center"><input type="submit" value="Next" class="btn" /></p>

			</fieldset>
		</form>
	</div>
</div>
<!-#END Confirm Payment Amount //-->

